Alternative Treatment
The preferred route of administration of antibiotics for treatment of Lyme arthritis is not clear. One option is to treat initially with oral antibiotics and administer a course of intravenous antibiotics to non-responders.
Intravenous antibiotics are recommended for treating neurologic disease. One exception is isolated Bell’s palsy, for which oral regimens are acceptable. Approximately 60 percent of patients with late neurologic disease have significant improvement when treated with antibiotics. An additional 20 percent of patients respond initially, then relapse. Improvement may not begin until several months after initiating therapy.
Symptoms persist in some patients despite appropriate treatment. The explanation of such cases is controversial. Potential causes of persistent symptoms include irreversible tissue damage, ongoing autoimmune response, persistent spirochetosis, and misdiagnosis.
| Table 2 Treatment of Lyme Disease | |||
| Drug | Adult Dosage | Pediatric Dosage | |
|---|---|---|---|
| Early Disease Erythema Migrans |
1. *Doxycycline | 100mg po bid x 14-21 days | Contraindicated |
| 2. Amoxicilin | 500mg po tid x 14-21 days | 10mg/kg po tid x 10-21 days | |
| Cefuroxime Axetil | 500mg po tid x 14-21 days | ||
| Arthritis | |||
| Oral | 1. *Doxycycline | 100mg po bid x 28 days | Contraindicated |
| 2. Amoxicillin | 500mg po tid x 28 days | 15 mg/kg po tid x 28 days | |
| Parenteral | 1. Ceftriaxone | 2 g IV qd x 14-28 days | 50-75 mg/kg IV qd x 14-28 days |
| 2. Penicillin G | 4 million U IV q4h x 14-28 days | 50,000 U/kg IV q4h x 14-28 days | |
| Neurological Disease | |||
| General Early or Late |
1. Ceftriaxone | 2 g IV qd x 14-28 days | 75-100 mg/kg IV qd x 14-28 days |
| 2. Penicillin G | 4 million U IV q4h x 14-28 days | 50,000 U/kg IV q4h x 14-28 days | |
| 3. Cefotaxime | 2 g IV q8h x 14-28 days | 30-60 mg/kg IV tid x 14-28 days | |
| Isolated Facial Palsy | 1. *Doxycycline | 100mg po bid x 21-28 days | Contraindicated |
| 2. Amoxicillin | 500mg po tid x 21-28 days | 8-15 mg/kg po tid x 21-28 days | |
| Cardiac | |||
| Mild | 1. *Doxycycline | 100mg po bid x 21 days | Contraindicated |
| 2. Amoxicillin | 250-500mg po tid x 21-28 days | 8-15 mg/kg po tid x 21 days | |
| Serious | 1. Ceftriaxone | 2 g IV qd x 14-21 days | 50-75 mg/kg IV qd x 14-21 days |
| 2. Penicillin G | 4 million U IV q4h x 14-21 days | 50,000 U/kg IV q4h x 21 days | |
* Note that Doxycycline should not be given to pregnant or lactating women, nor should it be given to children less than 8 years old.
